Volume 106 · Issue 31 · 2026

Obesity is a chronic metabolic disease requiring long-term intervention and sustained behavioral management. Given the current paucity of systematic education and support standards in obesity care, this paper proposes the obesity self-management education and support (OSMES) framework, modeled on the mature theoretical and practical foundations of diabetes self-management education and support framework. Grounded in the L.I.F.E.care four-dimensional model: load management (L), integration fitness (I), form optimization (F), and equilibrium mindset (E). The framework establishes 6 core standards: support system development, target population assessment, multidisciplinary team collaboration, service design and delivery, person-centered longitudinal care, and outcome evaluation with continuous quality improvement. Unlike traditional approaches focusing solely on weight reduction, OSMES elevates body form, functional capacity, and psychological well-being to equal importance alongside metabolic indicators. Considering China′s healthcare context, the framework explores collaborative models between medical institutions and third-party organizations, diversified payment pathways, and digital remote support to provide an implementable reference for long-term obesity management.

Neuroendocrine neoplasms (NEN) can be diffusely distributed throughout the body, with the digestive system being the most common. In recent years, the incidence of NEN has been increasing year by year. However, due to significant lag in related research and insufficient understanding of medical workers, it is prone to missed diagnosis, misdiagnosis, and mistreatment in clinical practice. Combining domestic and foreign literature, guidelines, and the author′s research from the clinical practice, the article introduces the clinical characteristics, endoscopic minimally invasive diagnosis and treatment, and comprehensive diagnosis and treatment of NEN in various parts of the digestive system. It aims to provide reference for standardized diagnosis and treatment of NEN, and to offer precise and individualized whole-course management plans.

The incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NET) has been on the rise, and the treatment strategies for advanced cases have become increasingly diverse. This article aims to explore the evolution of the drug treatment landscape for advanced GEP-NET, systematically reviewing the evidence-based medical progress of core approaches such as somatostatin analogues, targeted therapy, chemotherapy, immunotherapy, and peptide receptor radionuclide therapy. On this basis, it focuses on analyzing challenges currently faced in clinical decision-making, such as optimizing treatment sequences, overcoming drug resistance mechanisms, and developing biomarkers. Expert opinions and prospects based on clinical practice were proposed regarding future directions such as drug combination strategies, exploration of novel therapies, and precision treatment models to explore the current status and future of advanced GEP-NET drug therapy.

The incidence of pancreatic neuroendocrine tumor (pNET) is increasingly year by year. While curative resection is the primary treatment, with observation and follow-up generally adopted postoperatively, the risk of recurrence after surgery is high. The role of adjuvant therapy for patients with pNET after surgery remains controversial, with international guidelines favoring a risk-stratified approach and Chinese guidelines recommending adjuvant therapy for high-risk patients (with lymph node metastasis or high-grade tumors). Combining domestic and international guidelines as well as research evidence, this article systematically elaborates on the current status and advances of postoperative adjuvant therapy in patients with pNET, ranging from identification of risk factors for postoperative recurrence (clinical and pathological factors, biochemical markers, imaging factors, and predictive models) to therapeutic decision-making [somatostatin analogs (SSA), targeted therapy, chemotherapy, peptide receptor radionuclide therapy (PRRT)], so as to provide reference for clinical decision-making.

Hypoglycemic drugs targeting at nutrient-stimulated hormone (NuSH) receptors, including glucagon like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists and dual glucagon (GCG)/GLP-1 receptor agonists, not only exhibit the beneficial metabolic effects, such as lowering blood glucose, reducing body weight, lowering blood pressure, improving lipid profiles and attenuating hepatic steatosis, but also have demonstrated cardiovascular and renal benefits. The continual innovation and advancement of novel drugs, along with the continuous accumulation of evidence-based medical evidence, have offered more options for the clinical management of type 2 diabetes mellitus (T2DM). Based on these developments, Endocrinology and Metabolism Professional Committee, National Association of Health Industry and Enterprise Management searched recent literature and evaluated its evidence, and organized endocrinology specialists to conduct multiple rounds of rigorous deliberation and repeated revisions to complete the update of the consensus, on the basis of the 2020 version of the Consensus recommendations on utilizing glucagon-like peptide-1 (GLP-1) receptor agonists in the treatment of type 2 diabetes mellitus.The consensus focuses on the timing and applicable population of NuSH receptor agonists in T2DM, the precautions when combined with other hypoglycemic drugs, the impacts on cardiovascular, renal or hepatic outcomes, forming 10 recommended opinions aimed at providing reference for clinical doctors to standardize the use of such drugs and better serve T2DM patients.

Bone and soft tissue sarcomas are highly heterogeneous malignant tumors originating from mesenchymal tissues. 20%-25% of bone and 10%-15% of soft tissue sarcoma patients present with metastases at diagnosis, with another 30%-50% progressing during treatment. Currently, chemotherapy remains the primary first-line treatment for advanced disease. However, standard protocols for second-line and subsequent treatments are lacking, and immunotherapy is effective only in limited subtypes. Anti-angiogenic tyrosine kinase inhibitor (TKI), by inhibiting angiogenesis and remodeling the tumor microenvironment, has demonstrated promising clinical prospects, expanding their application scope from second-line and subsequent therapies to first-line combination TKI, maintenance, and neoadjuvant settings. To standardize the clinical application of TKI, the Sarcoma Expert Committee of the Chinese Society of Clinical Oncology (CSCO) organized 51 experts and developed this consensus based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, systematically integrating domestic and international evidence-based medical data up to October 2025, combined with expert clinical experience. This consensus focuses on the application of TKI in bone and soft tissue sarcomas, identifies the 8 core clinical questions and formulates 12 recommendations covering indication selection, timing of administration, combination strategies, perioperative management, and adverse event management, aiming to provide scientific guidance for Chinese clinicians to standardize their use in sarcoma treatment, enhance therapeutic efficacy, and improve patient prognosis.

To analyze the clinical and pathological characteristics of patients with pancreatic neuroendocrine neoplasms (pNEN) and the factors influencing mortality.

Patients with pNEN admitted to the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2024 were retrospectively included. Clinical data, imaging findings, pathological classification and grading, TNM staging, treatment modalities, and follow-up data were collected, with follow-up until June 30, 2025. The above relevant characteristics of patients with pNEN were analyzed. The Kaplan-Meier method was used to plot survival curves, and multivariate Cox regression model was adppted to identify factors influencing mortality in patients with pNEN.

A total of 196 pNEN patients were included, comprising 99 males and 97 females, with age of (55±13) years; There were 169 cases with non-functional pNEN, and 27 cases with functional pNEN (all insulinomas). In imaging examinations, the accuracy rates of CT, MRI, and endoscopic ultrasound (EUS) were 95.9% (187/195), 95.5% (64/67), and 100.0% (59/59), respectively; the pathological positivity rate for EUS-guided fine-needle aspiration biopsy was 89.5% (34/38), 91.8% (180/196) of patients received surgical treatment. In pathological classification and staging, there were 49, 115, and 13 cases of neuroendocrine tumors (NET) graded G1, G2, and G3, respectively, accounting for 25.0%, 58.7%, and 6.6%, respectively; neuroendocrine carcinoma (NEC) and mixed neuroendocrine-non-neuroendocrine tumors (MiNEN) were observed in 16 and 3 cases, respectively, accounting for 8.2% and 1.5%. In TNM staging, there were 58 cases (29.6%) in stage Ⅰ, 77 cases (39.3%) in stage Ⅱ, 29 cases (14.8%) in stage Ⅲ, and 32 cases (16.3%) in stage Ⅳ. In terms of treatment methods, 180 patients (91.8%) underwent surgical treatment, while 16 patients (8.2%) did not undergo surgical treatment. The follow-up duration [M (Q₁, Q₃)] was 38 (25, 49) months, with a total of 27 patients dying, and the median survival time was not reached. Univariate Cox regression analysis indicated that pathological classification and grading as NET G3 (HR=82.95, 95%CI: 22.21-309.75), NEC (HR=189.14, 95%CI: 48.37-739.55) and TNM staging as stage Ⅲ or Ⅳ (HR=0.32, 95%CI: 0.11-0.89) were all factors associated with mortality in pNEN patients.

pNEN are most commonly non-functional and classified as NET G2; pathological classification and grade NET G3, NEC, and TNM stages Ⅲ or Ⅳ are factors for mortality in patients with pNEN.

To compare the screening efficacy of different evaluation indicators of peak expiratory flow (PEF) for chronic obstructive pulmonary disease (COPD), and to assess the consistency of different evaluation indicators of PEF with forced expiratory volume in one second (FEV₁) measured value% predicted value when grading the severity of airflow limitation.

A retrospective analysis was conducted on data from 1 512 patients clinically suspected of COPD who underwent pulmonary function test at the Pulmonary Function Laboratory of China-Japan Friendship Hospital between May 2023 and May 2024. Pulmonary function test results were collected, including post-bronchodilator FEV₁/forced vital capacity (FVC), pre-bronchodilator FEV₁ measured value% predicted value, pre-bronchodilator PEF measured value, pre-bronchodilator PEF measured value divided by height², pre-bronchodilator PEF measured value % predicted value, post-bronchodilator PEF measured value, post-bronchodilator PEF measured value/height², and post-bronchodilator PEF measured value% predicted value. Receiver operating characteristic (ROC) curve was used to evaluate the screening performance of different PEF indicators for detecting impaired lung function, with calculation of the area under the curve (AUC), differences in AUC among indicators, and 95%CI for both AUC values and their differences. Kappa consistency tests were performed to assess agreement between PEF measured value/height² and PEF measured value% predicted value with FEV₁ measured value% predicted value in evaluating the severity of airflow limitation.

Among 1 512 clinically suspected patients with COPD, 1 258 were male and 254 were female, with age of (65.68±9.02) years. The AUC (95%CI) for different PEF indicators in screening COPD, ranked from highest to lowest, were as follows: pre-medication PEF measured value% predicted value [0.881 (0.861-0.901)], post-medication PEF measured value% predicted value [0.879 (0.858-0.899)], pre-medication PEF measured value/height² [0.869 (0.847-0.890)], post-medication PEF measured value/height² [0.865 (0.843-0.887)], pre-medication PEF measured value [0.843 (0.818-0.867)], and post-medication PEF measured value [0.837 (0.813-0.862)]. After pairwise comparison of the six indicators, it was found that regardless of pre-medication or post-medication, the AUC of PEF measured value was the lowest, followed by PEF measured value/height², and the AUC of PEF measured value% predicted value was the highest (except for pre-medication PEF measured value/height² vs post-medication PEF measured value% predicted value: P=0.067, all others P<0.05); and there was no statistically significant difference in the AUC of PEF measured value, PEF measured value/height², and PEF measured value% predicted value before and after medication (all P>0.05). The predictive performance of different PEF indicators for airflow limitation before medication all showed that in extremely severe, mild, and severe airflow limitation, the AUC of PEF measured value% predicted value was the highest, followed by PEF measured value/height², and the AUC of PEF measured value was the lowest (all P<0.05). However, in moderate airflow limitation, there was no significant difference in the predictive performance of different PEF indicators before medication (all P>0.05). The consistency of PEF measured value% predicted value and PEF measured value/height² in evaluating mild airflow limitation was relatively high (Kappa values were 0.671 and 0.611, respectively), and PEF measured value% predicted value was higher than PEF measured value/height²; in moderate, severe, and extremely severe airflow limitation, the consistency of the two indicators with FEV₁ measured value% predicted value was moderate or poor.

The percentage of the measured PEF value relative to the predicted value demonstrates the highest screening efficacy for COPD and no bronchodilation test is required; with the exception of mild airflow limitation, PEF is not an appropriate alternative to FEV₁ for classifying the severity of airflow obstruction.

To investigate the diagnostic value of B-type natriuretic peptide (BNP) for acute heart failure (AHF) in acute dyspnea patients with different renal function statuses and to develop a diagnostic model for AHF by integrating BNP with multiple clinical variables.

A retrospective analysis was conducted on patients presenting with acute dyspnea as the primary or initial symptom who were admitted to the Emergency Department of Peking University First Hospital between January 2019 and June 2023. Demographic characteristics, clinical features, and laboratory parameters were collected as candidate variables. Renal function was assessed using the estimated glomerular filtration rate (eGFR) and classified into different stages. Least absolute shrinkage and selection operator (LASSO) regression was applied to 34 candidate variables to identify variables associated with AHF diagnosis. Receiver operating characteristic (ROC) curve analysis was performed for the selected variables. The diagnostic performance of BNP across different renal function subgroups was further evaluated using ROC analysis. Subsequently, 5 predictive models, including logistic regression, random forest, Light Gradient Boosting Machine (LightGBM), Extreme Gradient Boosting (XGBoost), and Adaptive Boosting (AdaBoost), were developed based on the selected variables. Model performance was assessed using the area under the curve (AUC) of ROC, calibration curves, and decision curve analysis (DCA). Differences in the AUC across subgroups were compared using the DeLong test. Model interpretability was evaluated using Shapley additive explanations (SHAP).

Among the 605 enrolled patients, 236 (39.0%) were diagnosed with AHF and 369 (61.0%) were classified as non-AHF. LASSO regression identified seven variables associated with AHF diagnosis, including history of diuretic use, diabetes mellitus, previous cardiac dysfunction, persistent atrial fibrillation, acute myocardial infarction, eGFR stage, and BNP level. Among the selected variables, BNP demonstrated the highest diagnostic performance for AHF, with an AUC of 0.949 (95%CI: 0.931-0.967), an optimal cutoff value of 488 ng/L, a sensitivity of 80.9%, a specificity of 96.7%, and a Youden index of 0.777. In patients with eGFR≥60 ml·min^-1·(1.73 m²)^-1 and eGFR<60 ml·min^-1·(1.73 m²)^-1, the AUC of BNP for diagnosing AHF were 0.944 (95%CI: 0.902-0.987) and 0.938 (95%CI: 0.913-0.962), respectively, with no significant difference between the 2 groups (P=0.793). The logistic regression, random forest, AdaBoost, LightGBM, and XGBoost models achieved AUC of 0.956 (95%CI: 0.937-0.972), 0.944 (95%CI: 0.925-0.962), 0.940 (95%CI: 0.918-0.960), 0.931 (95%CI: 0.909-0.952), and 0.929 (95%CI: 0.905-0.951), respectively. The logistic regression model demonstrated the best overall discrimination, with a sensitivity of 87.7%, a specificity of 91.6%, and a Youden index of 0.793. Hosmer-Lemeshow testing, calibration curves, and DCA further indicated good calibration and clinical utility of the logistic regression model. SHAP analysis identified BNP as the most influential predictor, with the highest mean absolute SHAP value (4.278).

BNP exhibited high diagnostic value for AHF regardless of renal function status. The logistic regression model incorporating BNP and routinely available clinical indicators demonstrated excellent diagnostic performance, calibration, and clinical utility, and may serve as a useful tool for assisting the diagnosis of AHF in emergency settings.

To investigate the effect and mechanism of chloroquine on the growth of pancreatic neuroendocrine tumors (pNET).

This study was divided into animal experiments and cell experiments. (1) Animal experiments: ten male BALB/c nude mice, 6-8 weeks old, were selected. The suspension of QGP-1 cells (human pNET cell line) in the logarithmic growth phase was inoculated subcutaneously into the right axilla of nude mice to establish a subcutaneous xenograft tumor model. According to the random number table method, the mice were divided into a control group (intraperitoneal injection of physiological saline, once a day) and a chloroquine group (intraperitoneal injection of 50 mg/kg chloroquine, once a day), with 5 mice in each group. The treatment was administered continuously for 4 weeks. At the end of the 4th week, the mice were sacrificed, and the long diameter and weight of the transplanted tumors in each group were compared. The expression level of Ki-67 in tumor tissues was detected by immunohistochemistry (IHC) method, and tumor cell apoptosis was detected by TUNEL fluorescence staining. (2) Cell experiments: the cells used were human pNET cell line QGP-1 and pNET tissues (primary PNET cells) isolated from patients diagnosed with pNET at the First Affiliated Hospital of Nanjing Medical University who underwent surgical resection. Primary PNET cells were treated with 0, 10, 20, 40, 80, and 100 μmol/L chloroquine, and were respectively named the blank group [adding an equal volume of dimethyl sulfoxide (DMSO)] and 10, 20, 40, 60, 80, 100 μmol/L groups; QGP-1 cells were treated with 0, 20, 40, 60, 80, 100, and 160 μmol/L chloroquine, and were respectively named the blank group (adding an equal volume of DMSO) and 20, 40, 60, 80, 100, 160 μmol/L groups. After 24 hours of treatment, cell viability (absorbance A₄₅₀ nm value) was detected by cell counting kit-8 (CCK-8) method, and the half-maximal inhibitory concentration (IC50) was calculated. Based on the IC50 results, and combined with the long-term non-specific cytotoxicity, low-toxicity sub-lethal concentrations were selected for intervention in subsequent functional experiments. Cell proliferation ability was assessed by 5-ethynyl-2′-deoxyuridine (EdU) incorporation assay (proportion of EdU-positive cells) and plate colony formation assay (number of cloned cell formations). Cell migration (number of migrating cells) and invasion ability (number of invading cells) were detected using Transwell method. Cell cycle (proportion of cells in G0 or G1 phase) and apoptosis (early and late cell apoptosis rates) were analyzed by flow cytometry. Differentially expressed genes were screened using transcriptome sequencing, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed. The expression levels of pathway-related phosphorylated proteins [phosphorylated phosphatidylinositol 3-kinase (p-PI3K), phosphorylated protein kinase B (p-AKT), phosphorylated mammalian target of rapamycin (p-mTOR)] and autophagy-related proteins [ubiquitin-binding protein 62 (P62), key autophagy molecule Beclin-1 (Beclin1-1) and microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ)] were detected by Western blotting (WB).

(1) Animal experiments: tumors grew in both the control group and the chloroquine group, indicating successful modeling. The long diameter of the transplanted tumors in the chloroquine group was lower than that in the control group (P<0.05). There was no statistically significant difference in body weight between the chloroquine group and the control group at different administration times (days 1, 3, 5, 7, and 9 after administration) (all P>0.05). The proportion of Ki-67 positive cells in the chloroquine group was lower than that in the control group, while the proportion of TUNEL-positive cells (the number of apoptotic cells) was higher than that in the control group (P<0.05). (2) Cell experiments: after primary PNET cells were stimulated with different concentrations of chloroquine for 24, 48, and 72 h, the cell viability A₄₅₀ nm values of the 10, 20, 40, 60, 80, and 100 μmol/L groups at each time point were all lower than those of the blank group (all P<0.05); After QGP-1 cells were stimulated with different concentrations of chloroquine for 24, 48, and 72 h, the A₄₅₀ nm values of the 20, 40, 60, 80, 100, and 160 μmol/L groups at each time point were all lower than those of the blank group (all P<0.05). At 24 h of treatment, the IC50 values of primary PNET cells and QGP-1 cells were 67 and 101 μmol/L, respectively; therefore, in subsequent experiments, the blank group, 10 μmol/L group, and 20 μmol/L group were selected for primary PNET cells, and the blank group, 20 μmol/L group, and 40 μmol/L group were selected for QGP-1 cells. The proportion of EdU-positive cells, the number of cloned cell formations, and the number of migrating and invading cells in the 10 μmol/L and 20 μmol/L primary PNET cell groups were all less than those in the blank group, while the proportion of cells in the G1 phase and the apoptosis rate were all higher than those in the blank group (all P<0.05); additionally, the proportion of EdU-positive cells, the number of cloned cell formations, and the number of migrating and invading cells in the 20 μmol/L group of primary PNET cell were all less than those in the 10 μmol/L group, while the proportion of cells in the G0 or G1 phase and the (early and late) cell apoptosis rates were all higher than those in the 10 μmol/L group (all P<0.05). The proportion of EdU-positive proliferating cells, the number of cloned cell formations, and the number of migrating and invading cells in the 20 μmol/L and 40 μmol/L group of QGP-1 cell were all less than those in the blank group, while the proportion of cells in the G0 or G1 phase and the (early and late) cell apoptosis rates were all higher than those in the blank group (all P<0.05); additionally, the proportion of EdU-positive proliferating cells, the number of cloned formations, and the number of migrating and invading cells in the 40 μmol/L group of QGP-1 cell were all less than those in the 20 μmol/L group, while the proportion of cells in the G0 or G1 phase and the (early and late) cell apoptosis rates were all higher than those in the 20 μmol/L group (all P<0.05). Transcriptome sequencing analysis showed that differentially expressed genes were enriched in the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway; WB method results showed that the relative expression levels of phosphorylated proteins such as p-mTOR, p-PI3K, and p-AKT in the 20 μmol/L group of QGP-1 cells were lower than those in the blank group (all P<0.05); the relative expression levels of the autophagy substrate P62 and the autophagosome marker LC3-Ⅱ protein were higher than those in the blank group, while Beclin-1 was lower than that in the blank group (all P<0.05).

Chloroquine may inhibit the occurrence and development of pNET by suppressing the phosphorylation activation of the PI3K/AKT/mTOR signaling pathway and blocking autophagy.

A retrospective analysis was conducted on the neuroimaging features of white matter lesions related to patent foramen ovale and clinical characteristics (age, sex, history of hypertension and diabetes, etc.) of patients who underwent patent foramen ovale closure surgery at Fuwai Hospital, Chinese Academy of Medical Sciences, from February 2021 to June 2025. All patients were confirmed to have right-to-left shunt by contrast-enhanced transthoracic echocardiography and completed brain MRI examination. According to the results of contrast-enhanced transthoracic echocardiography, patients were divided into 2 groups (large-shunt group and non-large-shunt group). The distribution characteristics of white matter lesions were investigated from multiple dimensions, including anterior/posterior circulation, left/right hemisphere, and single/multiple lesions. A total of 118 patients were screened, among whom 100 with complete clinical data were included in the study. The age was (45.4±9.9) years. There were 62(62%) cases in the large-shunt group and 38(38%) cases in the non-large-shunt group. No statistically significant differences were found between the 2 groups in terms of age, gender, or history of hypertension, diabetes, stroke or transient ischemic attack (TIA). The proportion of multiple white matter lesions in the large-shunt group was significantly different [59.7%(37/62) vs 39.5%(15/38), P=0.049], as was the proportion of bilateral hemispheric distribution [62.9%(39/62) vs 42.1%(16/38), P=0.042]. The proportion of lesions distributed in the right hemisphere was higher [66.1%(41/62) vs 47.4%(18/38)], but the difference did not reach statistical significance (P=0.064). Among patients with a history of stroke or TIA, the proportions of multiple, bilateral, and involvement of both anterior and posterior circulation white matter lesions were significantly higher than those without such histor[66.1%(39/59) vs 31.7%(13/41), 67.8%(40/59) vs 36.6%(15/41), 62.7%(37/59) vs 26.8%(11/41), all P<0.01]. No statistically significant difference in white matter lesions distribution was observed between patients with and without a history of migraine. Patients with patent foramen ovale and a large right-to-left shunt are more likely to present with bilateral and multiple cerebral white matter lesions on brain MRI, and these white matter lesions are more prone to occur in the right hemisphere.

To explore the clinical characteristics of patients with Langerhans cell histiocytosis (LCH) and the risk factors for the occurrence of central diabetes insipidus(CDI). A retrospective analysis was conducted on the clinical data of 139 patients hospitalized for LCH at the First Medical Center of Chinese PLA General Hospital from October 2009 to March 2025. Among them, 76 were male and 63 were female, with the age at diagnosis of 21 (6, 39) years. The patients were divided into a CDI group (n=20) and a non-CDI group (n=119) according to the occurrence of CDI. Multivariate logistic regression analysis was used to identify the risk factors for CDI in patients with LCH. Among the 139 patients, single-system single-lesion LCH was the most common type (94/139, 67.6%), while multi-system involvement was observed in 39 cases (39/139, 28.0%). The most frequently involved organ was the bone (107/139, 77.0%). There were 24 cases (24/139, 17.3%) of LCH patients involving the central nervous system (CNS). Among them, 20 cases presented with CDI, and 10 cases (10/20, 50.0%) were complicated with anterior pituitary dysfunction. The proportions of patients with single-system single-lesion involvement and bone involvement in the CDI group were lower than those in the non-CDI group, while the proportions of patients with multisystem involvement without risk organ involvement, CNS involvement, skin and soft tissue involvement, and thyroid involvement were higher in the CDI group (all P<0.05). After adjusting for age, sex and body mass index, multivariate logistic regression analysis revealed that multi-system involvement without high-risk organ involvement (OR=6.868, 95%CI: 2.305-20.289), skin and soft tissue involvement (OR=6.318, 95%CI: 1.109-35.983), and thyroid involvement (OR=7.212, 95%CI: 1.053-49.395) were positively associated with the occurrence of CDI, while single-system single-lesion involvement (OR=0.323, 95%CI: 0.118-0.885) and bone involvement (OR=0.082, 95%CI: 0.027-0.253) were negatively associated with CDI. Among patients with LCH, those presenting with multisystem involvement without high-risk organ (liver, spleen, bone marrow) involvement, skin and soft tissue involvement, or thyroid involvement had higher odds of CDI.

The diagnosis and treatment of a local recurrence of rectal neuroendocrine tumor (rNET) 7 years after endoscopic submucosal dissection (ESD) was reported. The patient, a 56-year-old female, was seen in April 2024 for "7 years after rNET ESD and more than 1 year of shapeless stool". Seven years ago, the patient's postoperative pathology of ESD showed well-differentiated rNET grade G2, invasion of muscle propria, and positive resection margin. The patient refused additional radical surgery and only underwent colonoscopy follow-up. This case has the characteristics of local recurrence after long-term negative follow-up after non-curative resection. Because the stool was not formed for more than 1 year, this admission examination showed rectal occupation, and laparoscopic proctectomy combined with regional lymph node dissection was performed. Postoperative pathology confirmed local recurrence of rNET, and the stage was pT3N0M0. The patient was treated with long-acting octreotide after operation, and the patient was followed up until 14 Apr 2026. The patient's condition was stable. This case suggests that for patients with non-curative resection after ESD, additional radical surgery should be actively evaluated. Even if there is no abnormality in short-term reexamination, those without additional surgery still need long-term standardized follow-up, and the combination of endoscopic ultrasound and pelvic magnetic resonance should improve the detection rate of recurrence.

The diagnosis and treatment of a patient with gastric pyloric adenoma (PGA) with focal high-grade intraepithelial neoplasia after exon sequencing was reported. The patient, a 71-year-old female, was seen in Nanjing Gulou Hospital on June 29, 2024 due to "weakness of both lower limbs with dizziness for 3 months". Hemoglobin was 94 g/L in the local hospital, and abdominal CT showed that the small curved side of the stomach occupied space. Blood routine after admission showed hemoglobin 89 g/L; Thin-slice CT scan of stomach + enhancement showed multiple soft tissue shadows on the small curvature of stomach body; Gastroscopy revealed a 0~ Is type bulging lesion in the middle posterior wall of the stomach body; Endoscopic submucosal dissection was performed, and the pathology and final diagnosis were PGA with focal high-grade intraepithelial neoplasia. After symptomatic treatment, he improved and was discharged from hospital. Exon sequencing of resected specimens suggested that there were multiple gene mutations. Eight months after surgery (Mar. 7, 2025), the patient had no recurrence after reexamination of gastroscopy. This case suggests that for high-grade dysplasia PGA, clinicians should be alert to the phenomenon of multi-gene synergistic malignant evolution, and combine endoscopic block resection with cutting-edge multi-omics molecular detection to achieve individualized precise blockade of high-risk precancerous lesions.

High-grade neuroendocrine carcinoma (HG-NEC) is highly malignant and progresses rapidly, and the benefits of traditional platinum-containing chemotherapy drugs are not lasting. This article systematically combs the key evidence of HG-NEC in postoperative adjuvant and advanced multi-line therapy, summarizes the optimization of chemotherapy, immune combination therapy, anti-angiogenic therapy and other regimens, and summarizes the new targeted drugs represented by delta-like ligand 3 (DLL3). Research progress of drugs, including specific dual antibodies, tertiary antibodies and antibody-drug conjugates (ADCs); Finally, the current strategies are summarized from the perspective of efficacy and heterogeneity, and the potential value of molecular typing and circulating tumor DNA in patient stratification and efficacy monitoring is discussed, so as to summarize the research progress of HG-NEC drug therapy, and provide reference for new drug development and clinical application.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by cognitive, functional and behavioral disorders. The disease can significantly increase the risk of disability and dependence on life, and put tremendous pressure on the global medical and social care system. Until the emergence of biomarkers, a definitive diagnosis of AD can only be achieved by autopsy. Nowadays, the AT (N) framework based on beta amyloid, tau and neurodegeneration is gradually improved, and cerebrospinal fluid, positron emission tomography and blood markers (such as phosphorylated tau 217, beta amyloid 42/40, glial fibrillary acidic protein, etc.) can be used to characterize the complex evolution characteristics of AD and provide a basis for hierarchical decision-making. This paper systematically sorts out the cutting-edge evidence and typical diagnosis and treatment paths of AD, focusing on the diagnostic value of blood biomarkers, the decision-making gain of multi-index combination, and the application prospect of proteomics. At the same time, it proposes a hierarchical application path of biomarkers, and further analyzes the key issues of detection implementation, clinical translation and result interpretation in special situations. These advances are expected to more effectively cope with the heterogeneity and complex pathology of AD, and provide more solid support for the pathogenesis study, early diagnosis, disease course monitoring and efficacy evaluation of AD.

In ocean ships hundreds of years ago, scurvy was the fierce god of the sea that took the lives of countless sailors. The crew members' gums were festering, their bodies were covered with ecchymosis, and their wounds did not heal for a long time. Countless people did not dock alive. At that time, there were all kinds of folk remedies circulating, such as vinegar, seawater, herbs, sour wine…, but I don't know which one could really work. Scottish naval surgeon James Lind made an attempt in the cabin of the HMS Salisbury on May 20, 1747. He selected 12 sick sailors with similar symptoms, divided them into six groups, unified their daily diet, and only gave each group of sailors a control observation with different therapies. Some drank sour wine, some drank dilute sulfuric acid, some drank bitter seawater, and another group received oranges and lemons every day. In just six days, the two citrus-eating sailors were able to get up and work, while the other 10 were still suffering. This crude but rigorous trial is the starting point of modern human clinical trials and is the earliest well-documented randomized controlled trial. By dividing the subjects into groups and giving different dietary interventions, doctors confirmed that citrus fruits have a significant curative effect on scurvy, and their active ingredient is L-ascorbic acid, which was later isolated and identified. After that, lemon juice was popularized in the fleet, and scurvy, which had been rampant for a hundred years, gradually disappeared. Since then, humans have struggled with diseases, no longer relying on vague experience and folk rumors, but trying to find answers by comparing real human bodies. In order to remember this history, in 2005, the World Health Organization and the European Clinical Research Basic Network jointly initiated the establishment of May 20th every year as the "International Clinical Trial Day", hoping to inherit the scientific research values of rigorous, realistic and life-respecting. "520" is given a double meaning in the Chinese context: it is not only a well-known emotional confession, but also a silent but powerful commitment of the subject to the latecomer-"Don't be afraid, I tried it, and this road can go!"